State: Anthem can’t force customers to leave Central Maine Healthcare

Anthem Blue Cross and Blue Shield cannot force existing customers to stop seeing their current physicians in the Central Maine Healthcare system, state Superintendent of Insurance Eric Cioppa has decided.

Cioppa on Friday instructed Anthem, the state’s largest health insurance provider, to devise a new plan for its policyholders in southern and western Maine that imposes fewer restrictions on their options for subsidized care.

Anthem and MaineHealth, the state’s largest owner of hospitals and other medical facilities, have partnered to offer insurance on the health care exchange – or marketplace – created in Maine under the federal Affordable Care Act.

Their network will include 32 of the state’s 38 hospitals, excluding only Parkview Adventist Medical Center in Brunswick, York Hospital in York, Mercy Hospital in Portland and the three hospitals owned by Central Maine Healthcare of Lewiston.

The Bureau of Insurance held four public hearings on whether Anthem could transfer individuals to new insurance plans who were not grandfathered into their existing ones. The transfer would affect about 9,000 people, according to Anthem, which insures 320,000 Mainers who have many types of plan.

Cioppa’s decision, issued late Friday, was mixed.

He approved the proposed change in the six northern and eastern counties, where he said access to health care under Anthem’s plan was more than adequate.

However, Cioppa denied the proposed change in 10 southern and western counties including Cumberland, York and Kennebec counties.

“In the 10 southern and western counties, Anthem must either renew the existing coverage with modifications that are narrowly tailored to conform to the (Affordable Care Act), or if the plans are not renewed, the policyholders must be migrated to plans that retain the existing broad network and do not totally exclude benefits for out-of-network services,” the decision says.

Anthem and MaineHealth already have approval from the Maine Bureau of Insurance for the plan to partner on the health insurance exchange. Their provider network and pricing also have been approved.

Central Maine Medical Center has slammed the Anthem-MaineHealth plan as discriminating against insurance subscribers in central and western Maine, who could have to travel farther to reach doctors in the plan.

During the public hearings, some of Anthem’s policyholders also criticized the insurance provider for policies they said appeared to conflict with federal law and with statements made by President Obama that people who like their doctor or insurance plan can keep them under the Affordable Care Act.

The federal health care law, sometimes called Obamacare, passed in March 2010, and a number of provisions went into effect immediately.

Additional provisions went into effect Tuesday, including the launch of insurance exchanges in all 50 states, where consumers can shop for the plan that best suits them.

Under the individual mandate, which takes effect Jan. 1, failure to obtain coverage would incur a penalty.

One of the biggest remaining unknowns about the new system is how federal subsidies are going to be distributed for low-income Mainers who purchase insurance from the state’s exchange, officials have said.

Anthem is likely to be the biggest player in Maine’s new exchange.

A competing network is being offered by Maine Community Health Options, which offers coverage at 34 hospitals in Maine.

Anthem announced recently that it is changing its options for individual health plans.

Essentially, Anthem wants to discontinue its current plans and offer its 17,500 individual customers – and possibly many more individuals who currently are uninsured – other options.

About half of those customers will be grandfathered in, meaning their plans will not change. The other half will be subject to whatever changes the Bureau of Insurance approves.

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